Pharmacies across the country are expanding their businesses from prescription-dispensing operations to full industry partners in an effort to improve patient and business outcomes and control health care spending. These recent eight need-to-know developments illustrate the way retail and hospital pharmacies can drive more value from the health care delivery system.

Medication Synchronization

Pharmacy medication synchronization can save up to $37 in health care costs for each dollar spent

That’s according to a study in the American Journal of Managed Care. In “Cost-Benefit of Appointment-Based Medication Synchronization in Community Pharmacies,” researchers analyzed the return on investment in pharmacy-based medication synchronization programs for patients prescribed medications for high blood pressure, diabetes or high cholesterol. Pharmacies filled the patients’ multiple prescriptions on a scheduled, single day each month, and pharmacists preceded the monthly prescription pick up with a medication review and consultation with each customer. The researchers defined cost as the cost of additional prescriptions filled because of higher adherence driven by synchronization programs. They defined savings as the cost avoided from adherent patients not requiring medical care from providers because their conditions worsened from not taking their medications. For every additional dollar spent on filled prescriptions, patients avoided $1.25 to $36.96 in medical care, depending on the medication, according to the study. “These programs were shown to have a significant cost-benefit for health care payers by reducing medical utilization and costs. Payers should consider supporting the provision of these programs in community pharmacies, the researchers concluded.”

Synching meds through mail-order pharmacy drives double-digit improvement in adherence rates

The percentage of Medicare patients adherent with their prescription medications for three chronic conditions jumped as much as 26 percentage points after having multiple prescriptions synchronized by their mail-order pharmacy, said a study in Health Affairs. In “A Synchronized Prescription Refill Program Improved Medication Adherence,” researchers studied the adherence rates of Medicare patients with two to six prescription medications each to treat high blood pressure, high cholesterol and/or diabetes. The researchers defined adherence as the percentage of days covered by a day’s supply of medication with 80 percent or higher considered adherent. Of the nearly 1,400 patients in the study, about half had prescriptions synchronized by their mail-order pharmacy. The percentage of adherent patients with synchronized blood pressure meds rose to 86 percent from 83 percent; with cholesterol meds, to 75 percent from 67 percent; and with diabetes meds, to 77 percent from 67 percent. The biggest gains were seen in patients with the lowest initial adherence rates. For example, the percentage of low-adherent patients with synchronized cholesterol meds rose to 63 percent from 37 percent. “Synchronization can be easily combined with other types of interventions, based on a patient’s specific adherence challenges,” the researchers said.

Immunizations and Vaccines

Nearly 300,000 pharmacists in U.S. now trained to administer vaccines

Seven times more pharmacists in the U.S. are trained to administer vaccines to customers now than 20 years ago. That’s according to a 122-page report from the International Pharmaceutical Federation on the role of pharmacies in immunizing populations against diseases. In the report, An Overview of Current Pharmacy Impact on Immunization (PDF, 3 MB), the IPF surveyed 45 countries on how active pharmacists are in administering vaccines. The report said 13 of the 45 countries, including the U.S., now allow pharmacists to give vaccines. In the U.S., more than 280,000 pharmacists have been trained to administer vaccines, up from 40,000 in 2007. “Their high visibility and accessibility position community pharmacist at the heart of the health care system and in a strong position to deliver, communicate and disseminate positive messages about vaccination,” the report said.

Unvaccinated adults cost U.S. economy $9 billion a year, mostly in avoidable health care expenses

That’s according to a study in the journal Health Affairs. In “Modeling the Economic Burden of Adult Vaccine-Preventable Diseases in the United State,” researchers studied the economic impact of adults age 19 and older not getting a set of recommended vaccines. The set includes 10 vaccines that immunize adults from 14 diseases, including pneumonia, tetanus and influenza. The researchers said unvaccinated adults cost the U.S. economy $9 billion in 2015. About $8.5 billion, or 95 percent, were direct costs from inpatient and outpatient care and medication required by adults who got sick. About $500,000, or 5 percent, were indirect costs from lost productivity of adults who got sick and missed work. “The results of this study demonstrate the need for improved uptake of vaccines among adults based on a robust analysis of the societal and individual costs stemming from vaccine-preventable diseases among vaccinated and unvaccinated populations,” the researchers said.

Antibiotic Stewardship

CDC says more than 50% of hospitalized patients receive at least one dose of antibiotics during stay

Some 55.1 percent of patients received at least one dose of antibiotics during their hospital stay, according to figures reported by the Centers for Disease Control and Prevention in the journal JAMA Internal Medicine. In “Estimating National Trends in Inpatient Antibiotic Use Among U.S. Hospitals From 2006 to 2012,” CDC researchers said the rate of overall antibiotic use by hospital patients did not significantly change over that seven-year period. The CDC said the overall national antibiotic days of therapy for hospitalized patients was 755 per every 1,000 patient days. The agency did report that the use of specific antibiotics by hospitals, particularly broad-spectrum antibiotics, increased significantly. “This trend is worrisome in light of the rising challenge of antibiotic resistance,” the researchers said. “Our finding can help inform national efforts to improve antibiotic use by suggesting key targets for improvement interventions.”

Nurse practitioners and physician assistants more likely to prescribe antibiotics than physicians

That’s according to another CDC study, this one appearing in the journal Open Forum Infectious Diseases. In “ Outpatient Antibiotic Prescribing Among U.S. Nurse Practitioners and Physician Assistants,” CDC researchers examined 1.3 million ambulatory care visits. Of those visits, 6.3 percent involved nurse practitioners or physician assistants with the balance being visits with physicians only. Of the physician-only visits from 2006 to 2011, 12 percent resulted in an antibiotic being prescribed to the patient. Of the visits with NPs and PAs during that same period, 17 percent generated an antibiotic prescription. “As the proportion of outpatient visits involving NPs and Pas continues to increase, interventions to reduce inappropriate antibiotic use in ambulatory care should target these providers,” the researchers said.

Pharmacy Technology

Pharmacy automation market to reach $4.6 billion within three years

That’s according to a market projection from business research firm MarketsandMarkets. In its Pharmacy Automation Systems Market report, the firm said the size of the pharmacy automation systems market will rise more than 44 percent to almost $4.6 billion by 2019 from a little less than $3.2 billion in 2014. The report attributed the growth to the need for pharmacies to make their workflows more efficient as they fill and dispense more prescriptions and to improve patient safety by reducing medication-order errors.

Electronic prescribing reduces primary medication nonadherence rate by nearly half

That’s the finding of a study in the journal JAMA Dermatology. In “Association Between Method of Prescribing and Primary Nonadherence to Dermatologic Medication in an Urban Hospital Population,” researchers compared the primary nonadherence rates of patients who were prescribed medications electronically by an outpatient dermatology clinic and a peer group prescribed medications on paper. The study said primary nonadherence occurs when a patient fails to fill and pick up a prescription within one year of getting the prescription. The primary nonadherence rate for patients with paper prescriptions was 31.5 percent. By comparison, the primary nonadherence rate for patients with electronic prescriptions was 15.2 percent. “It is possible that having a paper prescription served as a tangible reminder for patients to fill and pick up their prescription in the short term,” the researchers said. “In the longer term, lost or misplaced paper prescriptions could have led to a diminished likelihood of full adherence.”

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